Graft ligament anchor and method for attaching a graft ligament to a bone

ABSTRACT

A graft ligament anchor comprises a graft ligament engagement member disposed in an opening in a bone, the graft ligament engagement member being arranged to receive a graft ligament alongside the engagement member, and a locking member for disposition in the opening, and at least in part engageable with the graft ligament engagement member. Movement of the locking member in the opening causes the locking member to urge the engagement member, and the graft ligament therewith, toward a wall of the opening, to secure the graft ligament to the wall of the opening. A method for attaching a graft ligament to a bone comprises providing an opening in the bone, inserting the graft ligament and a graft ligament engagement member in the opening, with the graft ligament disposed alongside a first portion of the engagement member, and inserting a locking member in the bone alongside a second portion of the engagement member, the locking member being separated from the graft ligament by the graft ligament engagement member. The method further comprises moving the locking member to cause the locking member to engage the graft ligament engagement member to urge the graft ligament engagement member, and the graft ligament therewith, toward a wall of the opening to secure the graft ligament to the wall of the opening.

CROSS-REFERENCES TO RELATED APPLICATIONS

This is a continuation of application Ser. No. 09/789,398, filed Feb.20, 2001 now abandoned, in the names of Joseph H. Sklar, Harold N.Martins, and Richard F. Wenstrom, Jr., which in turn is a continuationof application Ser. No. 09/304,885, filed May 4, 1999 now abandoned, inthe names of Joseph H. Sklar, Harold M. Martins, and Richard F.Wenstrorm, Jr., which in turn is a continuation of Ser. No. 08/756,413,filed Nov. 27, 1996, in the names of Joseph H. Sklar, Harold N. Martins,and Richard F. Wenstrom, Jr., now U.S. Pat. No. 5,899,938.

FIELD OF THE INVENTION

This invention relates to medical apparatus and methods in general, andmore particularly to apparatus and methods for reconstructing ligaments.

BACKGROUND OF THE INVENTION

Ligaments are tough bands of tissue which serve to connect the articularextremities of bones, or to support or retain organs in place within thebody. Ligaments are typically composed of coarse bundles of dense whitefibrous tissue which are disposed in a parallel or closely interlacedmanner, with the fibrous tissue being pliant and flexible, but notsignificantly extensible.

In many cases, ligaments are torn or ruptured as a result of accidents.As a result, various procedures have been developed to repair or replacesuch damaged ligaments.

For example, in the human knee, the anterior and posterior cruciateligaments (i.e., the ACL and PCL) extend between the top end of thetibia and the bottom end of the femur. The ACL and PCL cooperate,together with other ligaments and soft tissue, to provide both staticand dynamic stability to the knee. Often, the anterior cruciate ligament(i.e., the ACL) is ruptured or torn as a result of, for example, asports-related injury. Consequently, various surgical procedures havebeen developed for reconstructing the ACL so as to restore normalfunction to the knee.

In many instances, the ACL may be reconstructed by replacing theruptured ACL with a graft ligament. More particularly, with suchprocedures, bone tunnels are typically formed in the top end of thetibia and the bottom end of the femur, with one end of the graftligament being positioned in the femoral tunnel and the other end of thegraft ligament being positioned in the tibial tunnel. The two ends ofthe graft ligament are anchored in place in various ways known in theart so that the graft ligament extends between the femur and the tibiain substantially the same way, and with substantially the same function,as the original ACL. This graft ligament then cooperates with thesurrounding anatomical structures so as to restore normal function tothe knee.

In some circumstances the graft ligament may be a ligament or tendonwhich is harvested from elsewhere in the patient; in other circumstancesthe graft ligament may be a synthetic device. For the purposes of thepresent invention, all of the foregoing can be collectively referred toas a “graft ligament”.

As noted above, the graft ligament may be anchored in place in variousways. See, for example, U.S. Pat. No. 4,828,562, issued May 9, 1989 toRobert V. Kenna; U.S. Pat. No. 4,744,793, issued May 17, 1988 to Jack E.Parr et al.; U.S. Pat. No. 4,755,183, issued Jul. 5, 1988 to Robert V.Kenna; U.S. Pat. No. 4,927,421, issued May 22, 1990 to E. Marlowe Gobleet al.; U.S. Pat. No. 4,950,270, issued Aug. 21, 1990 to Jerald A.Bowman et al.; U.S. Pat. No. 5,062,843, issued Nov. 5, 1991 to Thomas H.Mahony, III; U.S. Pat. No. 5,147,362, issued Sep. 15, 1992 to E. MarloweGoble; U.S. Pat. No. 5,211,647, issued May 18, 1993 to ReinholdSchmieding; U.S. Pat. No. 5,151,104, issued Sep. 29, 1992 to Robert V.Kenna; U.S. Pat. No. 4,784,126, issued Nov. 15, 1988 to Donald H.Hourahane; U.S. Pat. No. 4,590,928, issued May 27, 1986 to Michael S.Hunt et al.; and French Patent Publication No. 2,590,792, filed Dec. 4,1985 by Francis Henri Breard.

Despite the above-identified advances in the art, there remains a needfor a graft ligament anchor which is simple, easy to install, andinexpensive to manufacture, while providing secure, trouble-freeanchoring of the graft ligament, typically in the knee joint of amammal.

OBJECTS OF THE INVENTION

Accordingly, one object of the present invention is to provide animproved graft ligament anchor which is relatively simple inconstruction and therefore inexpensive to manufacture, relatively easyto handle and install, and reliable and safe in operation.

Another object of the present invention is to provide an improved methodfor attaching a graft ligament to a bone.

SUMMARY OF THE INVENTION

These and other objects of the present invention are addressed by theprovision and use of a novel graft ligament anchor comprising graftligament engagement means for disposition in an opening in a bone, suchthat a wall of the graft ligament engagement means resides adjacent toat least one graft ligament disposed in the opening, and locking meansfor disposition in the opening in the bone and at least partiallyengageable with the graft ligament engagement means. The elements of thegraft ligament anchor are adapted such that movement of the lockingmeans in the opening in the bone causes at least a part of the lockingmeans to engage the graft ligament engagement means so as to urge thegraft ligament engagement means, and hence the portion of the graftligament disposed adjacent thereto, toward a wall of the opening in thebone, whereby to secure the graft ligament to the wall of the opening.

In use, an opening is made in the bone, and the graft ligament and thegraft ligament engagement means are inserted into the opening, with aportion of the graft ligament being disposed alongside a wall of thegraft ligament engagement means. In accordance with the presentinvention, the locking means are also positioned in the opening in thebone, alongside the graft ligament engagement means, with the lockingmeans being separated from the graft ligament by a portion of the graftligament engagement means. The method further includes moving thelocking means in the opening in the bone so as to cause at least aportion thereof to urge the graft ligament engagement means, and hencethe portion of the graft ligament disposed adjacent thereto, toward awall of the opening, whereby to secure the graft ligament to the wall ofthe opening.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other objects and features of the present invention will bemore fully disclosed or rendered obvious by the following detaileddescription of the preferred embodiments of the invention, which are tobe considered together with the accompanying drawings wherein likenumbers refer to like parts, and further wherein:

FIG. 1 is a diagrammatic sectional view of one form of graft ligamentanchor made in accordance with the present invention;

FIG. 2 is similar to FIG. 1, but shows the graft ligament anchorcomponents in different operating positions;

FIG. 3 is similar to FIG. 1, but shows an alternative embodiment of thepresent invention;

FIG. 4 is a diagrammatic sectional view of another form of graftligament anchor made in accordance with the present invention;

FIG. 5 is similar to FIG. 4, but shows the graft ligament anchorcomponents in different operating positions;

FIG. 6 is a diagrammatic sectional view of another form of graftligament anchor made in accordance with the present invention;

FIG. 7 is a diagrammatic sectional view of still another form of graftligament anchor made in accordance with the present invention;

FIG. 8 is a diagrammatic sectional view of yet another form of graftligament anchor made in accordance with the present invention;

FIG. 9 is a perspective view of one of the components of the graftligament anchor shown in FIG. 8;

FIG. 10 is a diagrammatic sectional view of still another form of graftligament anchor made in accordance with the present invention;

FIG. 11 is a diagrammatic view of still another form of-graft ligamentanchor made in accordance with the present invention;

FIG. 12 is a diagrammatic sectional view of yet another form of graftligament anchor made in accordance with the present invention;

FIG. 13 is similar to FIG. 12, but shows the graft ligament anchorcomponents in different operating conditions;

FIG. 13A is a diagrammatic sectional view of still another form ofligament anchor made in accordance with the present invention;

FIG. 14 is a top plan view of still another form of graft ligamentanchor made in accordance with the present invention;

FIG. 15 is a side view, in section, of the graft ligament anchor shownin FIG. 14;

FIG. 16 is a side view showing the graft ligament anchor of FIGS. 14 and15 securing a graft ligament to a bone;

FIG. 17 is similar to a portion of FIG. 16, but showing components ofthe graft ligament anchor and graft ligament of FIG. 16 in alternativepositions;

FIG. 18 is a top plan view of yet another form of graft ligament anchormade in accordance with the present invention;

FIG. 19 is a side view, in section, of the graft ligament anchor shownin FIG. 18;

FIG. 20 is a diagrammatic sectional view of still another form of graftligament anchor made in accordance with the present invention;

FIG. 21 is a perspective view of a component of the graft ligamentanchor shown in FIG. 20;

FIG. 22 is a diagrammatic sectional view of still another form of graftligament anchor made in accordance with the present invention; and

FIG. 23 is a perspective view of components of the graft ligament anchorof FIG. 22.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Referring first to FIG. 1, it will be seen that one illustrativeembodiment of the present invention includes a graft ligament engagementmeans 20 comprising a deformable sleeve 22, preferably formed out ofmetal or plastic, and adapted to be inserted into an opening 24 formedin a bone B. One or more graft ligaments 28 are disposed alongside aninterior wall 30 of sleeve 22.

The embodiment illustrated in FIG. 1 further includes locking means 32,which may be a pivotally movable rocker arm 34, which may be providedwith a slot 36 for receiving a key member (not shown) for turning rockerarm 34.

Referring to FIG. 2, it will be seen that turning rocker arm 34 enablesa portion of the rocker arm to impinge upon an exterior surface 40 ofsleeve 22 so as to force sleeve 22, and hence graft ligaments 28contained therein, toward sidewall 38 of opening 24, whereby to securesleeve 22 and graft ligaments 28 between opening sidewall 38 and lockingmeans 32.

In operation, opening 24 is first made in bone B and then graftligaments 28 and graft ligament engagement means 20 are inserted intoopening 24, with graft ligaments 28 being disposed alongside a firstwall, i.e., the interior wall 30, of sleeve 22. Locking means 32 areinserted into opening 24 alongside the exterior surface 40 of sleeve 22.Locking means 32 are thus separated from graft ligaments 28 by graftligament engagement means 20, i.e., sleeve 22. As noted above, movementof locking means 32 causes at least a portion thereof to engage sleeve22 and to crimp the sleeve inwardly upon graft ligaments 28, and to pushboth sleeve 22 and graft ligaments 28 against sidewall 38 of opening 24.

If it is desired to thereafter release graft ligaments 28, rocker arm 34may be moved back to the position shown in FIG. 1. To this end, graftligament engagement means 20 preferably are formed out of a resilientmaterial, whereby engagement means 20 can return to substantially thesame position shown in FIG. 1 when locking means 32 return to theposition shown in FIG. 1.

If desired, substantially all of sleeve 22 can be formed so as to bedeformable; alternatively, some of sleeve 22 can be formed so as to berigid. By way of example, the portion of sleeve 22 contacted by lockingmeans 32 can be formed so as to be substantially rigid.

Graft ligaments 28 may comprise natural or synthetic graft ligamentmaterial, and the anchor can be used to attach natural or syntheticgraft ligaments and/or tendons to bone. Sleeve 22 preferably is providedwith inwardly-extending protrusions 42, such as spikes 44, for securelyretaining graft ligaments 28 therein.

Locking means 32 may be a rocker arm type, such as the rocker arm member34 shown in FIGS. 1 and 2, or a generally conically-shaped expansionplug 46, as shown in FIG. 3, with the expansion plug preferably beingthreaded such that as the plug is screwed into place, an increasingdiameter of the plug engages sleeve 22 in a wedge-like manner so as toforce the sleeve against interior wall 38 of opening 24.

In FIG. 4, there is shown an alternative embodiment in which graftligaments 28 are disposed alongside exterior wall 40 of sleeve 22, andlocking means 32 is disposed within sleeve 22. With this embodiment,locking means 32 operate to engage interior wall 30 of the sleeve (FIG.5), whereby to force graft ligaments 28 against sidewall 38 of opening24. Again, locking means 32 may be a rocker arm type, such as the rockerarm member 34 shown in FIGS. 4 and 5, or may be an expansion plug 46,preferably threaded, of the sort shown in FIG. 3. With the embodimentshown in FIGS. 4 and 5, sleeve 22 may be provided with protrusions 42(in the form of spikes 44, for example) on the exterior wall 40 thereoffor engagement with graft ligaments 28. In many instances, it isbeneficial to provide at least two discrete graft ligaments 28 and, insuch cases, it is preferable that the graft ligaments be disposed onsubstantially opposite diametric sides of the sleeve, as shown in FIGS.4 and 5.

In FIG. 6, there is shown an embodiment similar to that shown in FIGS. 4and 5, but provided with an expandable sleeve 22A, rather than adeformable metal or plastic sleeve 22 as shown in FIGS. 1-5. Sleeve 22Amay be formed out of an elastomeric material, and it is expandedradially outwardly by engagement with a centrally disposed locking means32 (preferably in the form of a threaded expansion plug 46) so as toforce graft ligaments 28 outward into a secured position between sleeve22A and opening sidewall 38.

In operation, the embodiments shown in FIGS. 4-6 function similarly tothe embodiments shown in FIGS. 1-3 in attaching graft ligaments 28 tobone B. Opening 24 is first made in bone B. Graft ligaments 28 and graftligament engagement means 20 (in the form of sleeve 22 or sleeve 22A)are inserted into opening 24, with graft ligaments 28 disposed alongsideexterior wall 40 of the graft ligament engagement means, i.e., alongsidethe exterior wall 40 of sleeve 22 or sleeve 22A. Locking means 32 (inthe form of a rocker arm member 34 or a threaded expansion plug 46) areinserted axially into the sleeve, alongside interior wall 30 of thesleeve. Locking means 32 are thus separated from the graft ligaments 28by the sleeve (22 or 22A). Then locking means 32 are manipulated so asto engage the sleeve (22 or 22A) and thereby urge the sleeve, and hencegraft ligaments 28, toward opening sidewall 38, whereby to secure thesleeve and graft ligaments to the wall of the opening.

If and when it is desired to adjust tension on graft ligaments 28,locking means 32 may be backed off, that is, if locking means 32comprise the rocker arm type cam member 34, the arm need only be rotated90° from the positions shown in FIGS. 2 and 3, to return to thepositions shown, respectively, in FIGS. 1 and 4; if, on the other hand,locking means 32 comprise expansion plug 46, the plug need only beunscrewed or otherwise axially withdrawn so as to release the securingof the graft ligaments.

Referring next to FIG. 7, it will be seen that in an alternativeembodiment, graft ligament engagement means 20 comprises plate means 48which are movable transversely within the bone opening. As in theembodiments previously described, graft ligaments 28 are disposedalongside a wall 50 of graft ligament engagement means 20, which in thisinstance is a first major surface of plate means 48. Graft ligamentengagement means 20 are disposed between graft ligaments 28 and lockingmeans 32. Locking means 32 may be, as in the above-describedembodiments, an expansion plug 46 (as shown in FIG. 7), or locking means32 may be a rocker arm type of cam member 34 (of the sort shown in FIGS.1, 2, 4 and 5). Locking means 32 are adapted to impinge upon a secondmajor surface 52 of plate means 48. Plate means 48, in the embodimentshown in FIG. 7, comprises a single plate 54 having, on first majorsurface 50 thereof, one or more concavities 56 for nesting one or moregraft ligaments 28, respectively.

In the attachment of one or more graft ligaments 28 to a bone B, usingthe embodiment of FIG. 7, locking means 32 are manipulated so as to bearagainst plate 54 so as to move plate 54 into engagement with graftligaments 28, and thence to further move plate 54 so as to secure thegraft ligaments against sidewall 38 of opening 24.

Referring next to FIG. 8, it will be seen that locking means 32 maycomprise the threaded expansion plug 46 deployed partly in opening 24and threaded partly into bone B, thus serving as a so-calledinterference screw. With this arrangement, plug 46 is thereby (i) inpart along its length disposed in opening 24, protruding into theopening from opening wall 38, and (ii) in part along its lengththreadedly engaged with bone B. Screwing in plug 46 causes the plug toengage plate 54 which, in turn, compacts one or more graft ligaments 28against wall 38 of opening 24.

In lieu of, or in addition to, the aforementioned concavities 56 shownin FIG. 7, plate 54 may be provided with gripper ribs 58 for engaginggraft ligaments 28, as shown in FIGS. 8 and 9.

In FIG. 10, it is shown that plate means 48 may include first and secondplates 60, 62, each having a wall 50 facing one or more graft ligaments28, and a wall 52 facing locking means 32. Plates 60, 62 may be joinedtogether by a link 64 which may be molded integrally with plates 60, 62so as to form a so-called “living hinge” link. Locking means 32 aredepicted in FIG. 10 as a rocker arm type of cam member 34, but it willbe appreciated that an expansion plug type of locking means (e.g., aplug 46 such as that shown in FIGS. 3, 6 and 7) might also be used.

In operation, rotative movement of rocker arm 34 (or axial movement ofexpansion plug 46) causes plates 60, 62 to move outwardly from eachother so as to urge graft ligaments 28 against wall 38 of opening 24.Walls 50 of plates 60, 62 may be provided with concavities 56, as shownin FIG. 10, or with ribs 58 of the sort shown in FIG. 9, or both.

Referring next to FIG. 11, it will be seen that still another embodimentof the present invention includes, as graft ligament engagement means20, a V-shaped strip 94, preferably made out of a resilient metal orplastic material. An end portion 96 of a graft ligament 28 is disposedbetween first and second leg portions 98, 100 of V-shaped strip 94, andgraft ligament 28 extends alongside an exterior surface 102 of secondleg portion 100. Locking means 32 comprise a threaded expansion plug 46disposed partly in opening 24 and partly in bone B, along sidewall 38 ofopening 24, in a manner similar to the disposition of threaded expansionplug 46 shown in FIG. 8.

Upon screwing in expansion plug 46, the expansion plug engages first leg98 of graft ligament engagement means 20 (i.e., the V-shaped strip 94)to force first leg 98 to close upon second leg 100 with the graftligament end portion 96 sandwiched therebetween and, upon furtherscrewing in of threaded expansion plug 46, to force graft ligamentengagement means 20 and graft ligament 28 against wall 38 of opening 24.To release graft ligament 28, an operator need only back out expansionplug 46.

When attaching a graft ligament to a bone with the graft ligament anchorshown in FIG. 11, an opening is first drilled, or otherwise made, in thebone. Then the V-shaped strip 94 is inserted into the opening, with anose portion 104 thereof pointed inwardly of the bone. Next, end portion96 of graft ligament 28 is inserted between first and second legportions 98, 100 of V-shaped strip 94. Threaded expansion plug 46 isthen inserted into opening wall 38 such that a first portion 106 of thelengthwise extent of plug 46 is disposed in opening 24, and secondportion 108 of the lengthwise extent of plug 46 is threadedly engagedwith bone B. Expansion plug 46 is then screwed further down so as tocause plug 46 to engage first leg 98 of V-shaped strip 94 so as tosecure graft ligament end portion 96 in V-shaped strip 94, and thenscrewed down further to wedge strip 94 and graft ligament 28 againstwall 38 of opening 24.

Still referring to FIG. 11, it is to be appreciated that bone opening 24may be formed with a constant diameter throughout its length or, ifdesired, may be formed with two different diameters along its length, inthe manner shown in FIG. 11, so as to form an annular shoulder 110within the bone opening. The provision of an annular shoulder 110 can bevery helpful in ensuring that the graft ligament anchor is preventedfrom migrating further into bone B, even if graft-ligament 28 shouldthereafter be subjected to substantial retraction forces.

In a modification (not shown) of the FIG. 11 embodiment, the expansionplug 46 may be entered alongside graft ligament 28 and second legportion 100 of strip 94. In this modified version, the expansion plug 46operates as described above, except that expansion plug 46 engages graftligament 28 and forces strip first leg 98 against wall 38 of opening 24.

Looking next at FIGS. 12 and 13, yet another form of graft ligamentanchor is disclosed. This graft ligament anchor is similar to theembodiment shown in FIG. 6, except that the expandable sleeve 22B is inthe form of a cylindrical coil. Sleeve 22B is formed out of anelastomeric material and is expanded radially outwardly by engagementwith a centrally disposed locking means 32 (preferably anaxially-movable threaded expansion plug 46) so as to force graftligament 28 outward into a secured position between sleeve 22B and boneB.

In FIG. 13A there is shown an embodiment similar to that shown in FIG.10, but in which the first and second plates 60, 62 are discrete platesand not connected to each other. With this arrangement, locking means 32is inserted into a central recess 74 defined by plate walls 52, and maycomprise either an expansion plug 46 of the type shown in FIGS. 6 and 7or a rocker arm type of cam member 34 of the type shown in FIGS. 1 and2.

Looking next at FIGS. 14 and 15, another graft ligament anchor 200 isshown. Anchor 200 includes graft ligament engagement means 20 comprisinga flat plate 201, a pair of through-holes 202, 204 and a threadedthrough-hole 206. In use, and looking now at FIGS. 14, 15 and 16, thefree end 96 of graft ligament 28 is passed downward through hole 202 andthen back upward again through hole 204, and then a screw 208 is used tosecure anchor 200 to the wall 210 of the bone opening by threading theshank of screw 208 through hole 206, through graft ligament 28, and intobone B. This will cause screw 208 and plate 201 to securely attach graftligament 28 to bone B.

As shown in FIG. 17, alternatively, graft ligament 28 may be passedupwardly through hole 202 and downwardly through hole 204. Screw 208 isthen threaded through hole 206 and graft ligament 28 and into bone B.Thus, as in the embodiment shown in FIG. 16, screw 208 and plate 201secure graft ligament 28 to bone B.

FIGS. 18 and 19 show another graft ligament anchor 200A. Graft ligamentanchor 200A is similar to graft ligament anchor 200, except that itincludes a plurality of spikes 212 for projecting into wall 210 (FIG.16) of bone B when the graft ligament anchor is deployed against thebone. Also, graft ligament anchor 200A has an enlarged configuration 214in the region of through-hole 206A, as shown in FIG. 18.

Referring next to FIG. 20, there is shown a still further alternativeembodiment of graft ligament anchor, similar to that shown in FIG. 7,wherein graft ligament engagement means 20 comprises plate means 48formed in a U-shaped configuration (FIG. 21) movable transversely withinbone opening 24. At least one graft ligament 28 is disposed alongsidewall 50 of graft ligament engagement means 20, which in this instance isa first major surface of plate means 48. Graft ligament engagement means20 is disposed between graft ligament 28 and locking means 32. Lockingmeans 32 may be an expansion plug 46, as shown in FIG. 20 and in FIG. 7,or a rocker arm type cam member 34, as shown in FIG. 1, or aninterference screw type expansion plug 46, as shown in FIG. 11, or atransverse screw 208, as shown in FIG. 16.

In attachment of one or more graft ligaments 28 to a bone B, using theembodiment of FIG. 20, locking means 32 is manipulated so as to bearagainst a second major surface 52 of plate means 48 and thereby moveplate means 48 into engagement with graft ligament 28, and thence todrive free ends 49 of plate means 48 into sidewall 38 of opening 24 soas to fasten graft ligament 28 to sidewall 38 and, thereby, to bone B.

Referring to FIGS. 22 and 23, there is shown still another alternativeembodiment of graft ligament anchor including a tubular member 300, openat first and second ends 302, 304 and having an opening 306 in thesidewall thereof. Otherwise, the graft ligament anchor of FIG. 22 issimilar to the graft ligament anchor of FIG. 20, described hereinabove.

In attachment of one or more graft ligaments 28 to a bone, using theembodiment of FIGS. 22 and 23, locking means 32 are manipulated to bearagainst second major surface 52 of plate means 48 so as to move platemeans 48 through tubular member opening 306 and into engagement withgraft ligament 28, and thence further to drive free ends 49 of platemeans 48 into sidewall 38 of opening 24, whereby to fasten tubularmember 300 and graft ligament 28 to sidewall 38 and, thereby, to bone B.In this embodiment, and in the embodiments shown in FIGS. 1-3, anoperator may fasten the graft ligament to the bone without the graftligament contacting the bone. The tubular member 300 preferably is of aplastic or metallic material and the plate means 48 is of a plastic ormetallic material. In the embodiments shown in FIGS. 20 and 22, theplate means 48 may be provided with interior teeth 47 for gripping graftligament 28.

It is to be understood that the present invention is by no means limitedto the particular constructions and methods herein disclosed and/orshown in the drawings, but also comprises any modifications orequivalents within the scope of the claims.

1. A graft ligament anchor comprising: a flexible tubular sleeve fordisposition in an opening in a bone so that wall portions of said sleeveare disposed adjacent to opposed graft ligaments disposed in theopening; and a rocker arm of generally elliptical width-wisecross-section for disposition in the opening and engageable with saidsleeve and rotatable in said sleeve to cause the wall portions of saidsleeve to urge the graft ligaments outwardly from each other; wherebyrotational movement of said rocker arm in the opening causes endportions of said rocker arm to engage said sleeve so as to urge saidsleeve, and hence the graft ligaments, toward a wall of the opening,whereby to secure the graft ligaments to the wall of the opening.
 2. Thegraft ligament anchor according to claim 1, wherein the graft ligamentsare disposed alongside said wall portions of said sleeve.
 3. A graftligament anchor according to claim 1 wherein said sleeve is arranged soas to be disposed between said rocker arm and said graft ligaments.
 4. Agraft ligament anchor according to claim 1 wherein said sleeve is madeof metal.
 5. A graft ligament anchor according to claim 1 wherein saidgraft ligaments are disposed alongside exterior wall portions of saidsleeve.
 6. The graft ligament anchor according to claim 1 wherein saidrocker arm is disposed inside of said sleeve.
 7. A graft ligament anchoraccording to claim 1 wherein said sleeve accommodates the opposed graftligaments alongside an exterior wall of said sleeve, and said rocker armis arranged within said sleeve, and said rocker arm is operable to urgesaid sleeve, and the graft ligaments, against the wall of the opening.8. A graft ligament anchor according to claim 7 wherein said sleeve isadapted to accommodate the graft ligaments on substantially oppositediametric sides of said sleeve.
 9. A method for attaching graftligaments to a bone, said method comprising the steps of: providing anopening in the bone; inserting the graft ligaments and a sleeve in theopening, with the graft ligaments disposed alongside the sleeve;inserting a rocker arm of generally elliptical width-wise cross-sectionin the opening inside the sleeve, the rocker arm being separated fromthe graft ligaments by the sleeve; and moving the rocker arm to causeend portions of said rocker arm to engage the sleeve to urge the sleeve,and hence the graft ligaments, toward a wall of the opening to securethe graft ligaments to the wall of the opening.
 10. A method accordingto claim 9 wherein the sleeve comprises a deformable sleeve.